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Title: Advanced applications of cardiac computed tomography for the difficult-to-image patient
Author: Clayton, Benjamin James
ISNI:       0000 0004 5917 6449
Awarding Body: University of Plymouth
Current Institution: University of Plymouth
Date of Award: 2015
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Throughout the development of computed tomographic (CT) imaging the challenges of capturing the heart, with its perpetual, vigorous motion, and in particular the tiny detail within the coronary arteries, has driven technological progress. Today, CT is a widely used and rapidly growing modality for the investigation of coronary artery disease, as well as other cardiac pathology. However, limitations remain and particular patient groups present a significant challenge to the CT operator. This thesis adds new knowledge to the assessment of these difficult-to-image patients. It considers patients with artefact from coronary artery calcification or stents, examining the remarkable diagnostic performance of high definition scanning, as well as material subtraction techniques using dual energy CT, alongside ways in which current technology might be revisited and refined with the use of alternative image reconstruction methods. Patients with challenging heart rate or rhythm abnormalities are considered in three studies; how to achieve diagnostic image quality in atrial fibrillation, the safety of an aggressive approach to intravenous beta-blocker use prior to coronary imaging, and the development of patient information to address anxiety as a source of tachycardia and motion artefact. Finally, the novel application of a single source, dual energy CT scanner to additional cardiac information is considered, with studies of myocardial perfusion CT and delayed iodine enhancement imaging, to identify ways in which non-coronary imaging might be exploited to more thoroughly evaluate a patient’s coronary artery status. These findings are presented in the context of developing technology and together offer a range of potential options for operators of cardiac CT when faced with a difficult-to-image patient.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Computed tomography ; Cardiac imaging ; Cardiology